A cheilectomy (pronounced “ky-LEK-tuh-me”) is a surgery that removes bone spurs and a portion of bone from your big toe joint so it can bend freely again. It’s the most common joint-preserving procedure for hallux rigidus, a form of osteoarthritis that makes your big toe stiff and painful. Unlike a joint fusion, which locks the toe in place permanently, a cheilectomy aims to keep the joint moving.
Why the Big Toe Stops Bending
Hallux rigidus develops when the cartilage in the joint at the base of your big toe wears down over time. As the cartilage thins, the bones respond by growing extra bone tissue along the edges of the joint. These bony growths, called bone spurs, physically block the toe from bending upward. Walking, pushing off during a step, or even wearing certain shoes becomes painful because the joint can’t move through its normal range.
The condition progresses through stages. In the earliest phase, you might notice occasional stiffness and pain only at the extremes of motion. By the moderate stages, you’ve lost 50% to 75% of your normal upward toe bend, pain is more constant, and the top of the joint may feel enlarged or bumpy. In advanced stages, you lose nearly all movement and experience pain even in the middle of your range of motion, not just at the endpoints.
Who Is a Candidate for Cheilectomy
Cheilectomy is typically recommended after nonsurgical treatments have failed to provide enough relief. Those treatments usually include stiff-soled shoes or rocker-bottom shoes, anti-inflammatory medications, steroid injections, and activity modification. When pain and stiffness persist despite these measures, surgery becomes an option.
Surgeons use a grading system to decide which procedure makes the most sense. Cheilectomy works best for grades 1 through 3 on a widely used five-point scale (0 through 4). The longest follow-up study on record, averaging 9.6 years of tracking, found that cheilectomy performed well for patients up through grade 3 as long as less than half the cartilage on the metatarsal head was worn away. For the most advanced cases (grade 4), where cartilage loss is severe and pain occurs through the entire range of motion, a fusion or joint replacement is generally a better fit.
What the Surgery Involves
During a cheilectomy, the surgeon makes an incision along the top of the big toe joint. They remove the bone spurs from the metatarsal bone and the base of the toe bone, then shave off up to 30% of the top surface of the metatarsal head. That 30% is key: it’s the portion of bone that blocks upward bending. Removing it creates a new clearance zone so the toe can dorsiflex (bend upward) without bone hitting bone.
The procedure is performed as an outpatient surgery, meaning you go home the same day. It can be done under general anesthesia, regional nerve block, or a combination. The operation itself is relatively quick compared to more complex foot surgeries like fusion, and there are both traditional open and minimally invasive techniques available.
Recovery Week by Week
Recovery from a cheilectomy is significantly faster than from a joint fusion, which is one of the procedure’s main advantages. In the first week, the focus is on managing swelling and starting gentle movement. You’ll likely begin wiggling your toes, doing ankle circles, and using a stationary bike. A physical therapist may begin gently bending the big toe up and down (passively, meaning they move it for you) to prevent scar tissue from limiting your new range of motion. Hip and leg exercises keep the rest of your lower body strong while the toe heals.
During weeks two through four, the exercises ramp up. Standing heel raises, continued bike work, and more aggressive manual stretching of the big toe are typical. The goal by week four is to reach about 65 to 70 degrees of upward toe bend, which is close to normal and a major improvement over the pre-surgery range for most patients.
From week four onward, the emphasis shifts to functional movement: balance training, treadmill walking (forward and backward), and working toward a normal walking pattern with a full toe-off push. Jogging typically starts around 12 weeks. The physical therapy phase is critical. Without consistent stretching and mobilization, scar tissue can form and limit the range of motion that the surgery was designed to restore.
How Much Improvement to Expect
A large meta-analysis of cheilectomy outcomes found that the procedure improved range of motion by about 51%, taking patients from an average of roughly 41 degrees of movement to around 62 degrees. Functional scores on a standard foot and ankle assessment improved by about 34%. Patients with mild to moderate hallux rigidus reported the highest satisfaction levels.
The traditional open technique actually showed greater range-of-motion gains (about 68% improvement) compared to minimally invasive approaches (about 49% improvement). That doesn’t necessarily make one approach better overall, since minimally invasive techniques may offer faster initial healing, but it’s worth discussing with your surgeon if maximizing flexibility is your primary goal.
Success rates in the literature vary depending on how success is defined. Some studies report satisfaction rates around 90%, while others using stricter criteria found satisfaction closer to 69%, with about 29% of patients experiencing some return of pain after surgery. Around 8% of patients in one study eventually went on to have a fusion. Some residual stiffness or mild discomfort is common even after a successful cheilectomy, particularly in patients who had more advanced disease before surgery.
Cheilectomy vs. Joint Fusion
The biggest advantage of cheilectomy over fusion (arthrodesis) is that it preserves joint motion. After a fusion, the big toe is permanently fixed in one position. You lose the ability to bend it, which changes your gait and limits activities like running, squatting, or wearing heeled shoes. Fusion is highly effective at eliminating pain, but it trades motion for stability.
Cheilectomy keeps the joint intact and mobile, making it a better first option for active patients or younger people who want to preserve function. If a cheilectomy doesn’t provide enough relief, a fusion can still be performed later. The reverse isn’t true: once a joint is fused, the decision is permanent. For patients with end-stage hallux rigidus who specifically want to avoid fusion, a more aggressive version of cheilectomy (removing a larger portion of bone) can sometimes provide acceptable pain relief and improved function, though outcomes are less predictable at that stage.
Risks and Potential Complications
Cheilectomy is considered a low-risk procedure, but no surgery is without potential complications. The most commonly discussed risks include infection, nerve irritation or damage near the incision (which can cause numbness along the top of the toe), and stiffness if scar tissue builds up during recovery. Bone spurs can also regrow over time, though this tends to happen more in patients with advanced disease at the time of surgery.
The biggest long-term concern is that the underlying arthritis continues to progress. Cheilectomy addresses the mechanical problem (bone blocking motion) but doesn’t reverse cartilage loss. For some patients, the relief lasts many years. For others, particularly those who were already at a more advanced stage, the arthritis may eventually progress to the point where a second procedure is needed.